DACBSP cheat sheet

Concussion is a functional, not structural, brain injury: standard CT and MRI are typically normal, so diagnosis rests on clinical signs and symptom provocation.

SCAT-style evaluation sequence: symptoms and history, cognitive screening (orientation, immediate and delayed memory, concentration), neurological screen, balance (BESS) and coordination, then exertional provocation.

Red flags mandating urgent referral: worsening headache, repeated vomiting, seizure, focal deficit, unequal pupils, drowsiness, or symptoms worsening at rest.

Cervical spine must be cleared before provocative testing; neck pain and tenderness are independent predictors of slower recovery in sport-related concussion.

Vestibular/oculomotor findings (smooth pursuit, saccades, VOR, convergence) guide targeted rehabilitation rather than prolonged rest.

Return-to-sport is stepwise and requires full symptom resolution at rest, then graded exertion without recurrence; each step separated by roughly 24 hours.

Balance testing (BESS) is scored by counting errors over 20-second trials in double-leg, single-leg, and tandem stances, eyes closed, on firm and foam surfaces.

Cervical flexion-extension, rotation, and side-bending couple in predictable patterns; combined extension-rotation-axial load is the classic mechanism for facet and disc injury.

Lumbar flexion increases intradiscal pressure and posterior annular strain; extension increases facet load and foraminal narrowing, so directional preference testing drives exercise choice.

Spondylolysis in young athletes typically involves the pars interarticularis at L5; extension and rotation loading (e.g., repeated back extension) is the typical sport mechanism.

Shoulder stability depends on concavity-compression, negative intra-articular pressure, glenoid labrum, and capsuloligamentous restraints; the rotator cuff adds dynamic compression.

The throwing shoulder shows adaptive glenohumeral internal rotation deficit (GIRD) with total rotation often preserved; GIRD above roughly 20 degrees is a risk marker.

Anterior cruciate ligament strain peaks near 30 degrees of knee flexion with valgus and internal rotation moments; landing mechanics with knee-over-toe alignment reduce that load.

Ankle inversion sprains injure the anterior talofibular ligament first, then calcaneofibular, then posterior talofibular; the deltoid ligament fails with eversion.

Airway-breathing-circulation plus cervical spine control precedes all sport-specific evaluation; helmet and shoulder pads are removed only by trained personnel using a coordinated technique.

Suspected cervical injury: immobilize, maintain neutral alignment, transfer with log-roll or lift-and-slide, and do not remove protective equipment before transport unless airway compromise demands it.

Exertional heat stroke is a medical emergency: core temperature above 40 C with central nervous system dysfunction; immediate cold-water immersion is the treatment of choice.

Sickle cell trait collapse presents with cramping, weakness, and rhabdomyolysis after intense exertion; treat with aggressive hydration, cooling, and oxygen rather than assuming heat illness alone.

Commotio cordis: blunt precordial impact during the vulnerable repolarization window; immediate defibrillation and CPR are the only effective interventions.

Anaphylaxis in athletes: intramuscular epinephrine to the anterolateral thigh is first-line, followed by positioning supine with legs elevated and emergency transport.

Sideline emergency plan should specify roles, equipment location, communication, and evacuation route, and be rehearsed before the season begins.

Return-to-play decision combines tissue healing status, pain and swelling, strength and range-of-motion symmetry, functional testing, sport-specific demands, and risk of reinjury.

Strength criteria commonly used: quadriceps limb symmetry index of at least 90 percent and hamstring-to-quadriceps ratio near 0.6 before return after ACL reconstruction.

Hop and jump tests (single-leg hop, triple hop, crossover hop, timed 6-meter hop) compare limbs; a limb symmetry index below 90 percent signals incomplete readiness.

Tendinopathy progresses from reactive to disrepair stages; loading programs use progressive isometric, heavy slow resistance, then energy-storage exercises rather than rest alone.

Bone stress injury grading determines management: low-risk sites (posterior tibia, fibula) may allow modified loading, while high-risk sites (femoral neck, anterior tibia, navicular, fifth metatarsal base) often require non-weightbearing.

Relative energy deficiency in sport impairs bone healing and should be screened in athletes with recurrent or atypical stress injuries.

Concussion return-to-learn precedes return-to-sport; academic accommodations are staged before physical progression.

Ottawa ankle rules: imaging indicated with malleolar pain plus bone tenderness at the posterior malleolus or navicular, or inability to bear weight four steps immediately and in the clinic.

Ottawa knee rules: imaging for age 55 or older, isolated patellar tenderness, fibular head tenderness, inability to flex to 90 degrees, or inability to bear weight four steps.

Lachman test is the most sensitive examination for ACL rupture; the pivot-shift test is more specific but harder to reproduce in an acute, guarded knee.

Magnetic resonance imaging is the modality of choice for ligament, meniscus, cartilage, and bone marrow pathology; radiographs remain first-line for fracture and alignment.

Stress radiographs or dynamic ultrasound can quantify instability that static imaging misses, such as syndesmotic or medial elbow laxity.

Ultrasound is operator-dependent but useful for dynamic tendon, muscle, and ligament evaluation and for guided injections.

Bone scan and single-photon emission computed tomography are sensitive but nonspecific; magnetic resonance imaging is preferred for early bone stress injury detection.

Injury rates are reported per 1,000 athlete-exposures; an exposure is one athlete participating in one practice or competition.

Anterior cruciate ligament injury risk is highest in pivoting and cutting sports (soccer, basketball, handball, skiing) and is roughly two to eight times higher in female athletes in comparable sports.

Neuromuscular warm-up programs with plyometrics, strengthening, and landing feedback reduce ACL injury rates in youth athletes when performed consistently.

Overuse injuries dominate in endurance sport (running, cycling, swimming) and in throwing sports, where workload spikes precede injury.

Pitch counts and rest-day rules in youth baseball target cumulative throwing load, which is the strongest modifiable risk factor for elbow injury.

Catastrophic injury rates are highest in collision sports and in activities with high fall height (gymnastics, equestrian, cycling, cheerleading).

Injury surveillance definitions must specify time loss, recurrence, and severity (days lost) to allow comparison across studies.

Cryotherapy reduces tissue temperature, blood flow, and pain, and slows nerve conduction; it is applied for roughly 10 to 20 minutes with a barrier to prevent cold injury.

Therapeutic ultrasound at 1 MHz penetrates deeper (around 3 to 5 cm) than 3 MHz (around 1 to 2 cm); continuous mode heats, pulsed mode is used for nonthermal effects.

Electrical stimulation uses different frequencies for different goals: sensory-level for pain gating, motor-level for muscle contraction, and interferential currents for deeper pain modulation.

Nonsteroidal anti-inflammatory drugs blunt prostaglandin synthesis and can impair tendon and bone healing when used heavily around injury; they also carry gastrointestinal and renal risk.

Glucocorticoid injections relieve pain but repeated injections near tendons risk rupture; tendon injections are generally avoided.

WADA-prohibited classes include anabolic agents, peptide hormones, beta-2 agonists beyond permitted inhaled doses, and diuretics; therapeutic use exemptions are required for legitimate banned medication.

Corticosteroid injections are prohibited in competition by systemic routes but permitted by local injection under WADA rules; athletes should verify current status.

The preparticipation evaluation screens for cardiovascular risk: syncope with exertion, unexplained dyspnea, family history of sudden death before age 50, and a murmur warrant further workup.

Hypertrophic cardiomyopathy is a leading cause of sudden cardiac death in young athletes; screening includes history, physical examination, and electrocardiography where protocols call for it.

Exercise-associated bronchoconstriction in athletes is managed with warm-up, inhaled beta-2 agonist before exercise, and avoidance of cold dry air; asthma medications require WADA verification.

Type 1 diabetes management during sport requires glucose monitoring, carbohydrate availability, and awareness that exercise can cause delayed hypoglycemia hours later.

Female athlete triad and relative energy deficiency in sport involve low energy availability, menstrual dysfunction, and low bone mineral density, with consequences for stress fracture risk.

Athletes with a single kidney or prior splenectomy may need sport-specific counseling about collision risk, though most can participate with protective equipment.

Sickle cell trait screening and conditioning modifications reduce risk of exertional collapse in athletes with the trait.

Medical decisions about return to play should rest with the treating clinician, independent of coaching pressure; conflicts of interest must be disclosed.

Informed consent for sideline care and for procedures requires discussion of risks, benefits, alternatives, and the athlete's right to refuse.

Documentation should record mechanism of injury, examination findings, diagnosis, treatment, return-to-play status, and any restrictions.

Confidentiality rules (such as HIPAA in the United States) govern sharing of athlete health information with teams and media; minimum necessary disclosure applies.

Preseason planning should define emergency action plans, equipment availability, communication, and transport routes, and be shared with coaches and officials.

Clinicians should know the rules of the sport they cover, including substitution, injury timeouts, and equipment requirements, to advise accurately.

Research and educational activities involving athletes require ethics review and appropriate consent, particularly with minors.

Maximal oxygen uptake sets the ceiling for aerobic performance and is the product of cardiac output and arteriovenous oxygen difference.

Lactate threshold and respiratory compensation point mark sustainable intensity boundaries; training near threshold improves endurance performance more than steady subthreshold work alone.

The phosphagen system supplies energy for roughly 10 seconds of maximal effort; glycolysis dominates for about 30 seconds to 2 minutes; oxidative metabolism dominates thereafter.

Strength gains in the first weeks come largely from neural adaptation; hypertrophy follows with progressive loading over weeks to months.

Eccentric exercise causes delayed-onset muscle soreness peaking around 24 to 72 hours and produces a repeated-bout protective effect.

Heat acclimatization over 7 to 14 days increases plasma volume, sweat rate, and earlier onset of sweating, reducing heat strain.

Altitude exposure increases ventilation and erythropoietin; live-high, train-low protocols balance acclimatization with training quality.

Carbohydrate intake during exercise of 1 to 2.5 hours supports performance at roughly 30 to 60 grams per hour; longer events may use up to 90 grams per hour with multiple transportable carbohydrates.

Pre-exercise carbohydrate loading (roughly 8 to 12 grams per kilogram per day) supports glycogen stores before endurance events.

Protein needs for strength athletes are about 1.6 to 2.2 grams per kilogram per day, distributed across meals.

Dehydration of about 2 percent of body mass impairs endurance performance; replacement should approximate sweat losses measured by pre- and post-session weighing.

Hyponatremia risk rises with excessive plain water intake during long events; sodium-containing fluids and limiting overdrinking reduce risk.

Iron deficiency is common in endurance athletes, especially females; ferritin testing guides supplementation.

Supplement use should be checked against third-party testing programs because contamination is a real risk for doping violations.

Growth plate (physis) injuries are unique to skeletally immature athletes; traction apophysitides include Osgood-Schlatter (tibial tubercle) and Sever (calcaneus).

Little League shoulder and elbow injuries reflect repetitive throwing load on open physes; rest and workload reduction are central to management.

Youth resistance training is safe with qualified supervision, proper technique, and load progression; it is not inherently injurious to growth plates.

Adolescent athletes with concussion take longer to recover on average and require academic accommodations before return to sport.

Early sport specialization is associated with higher overuse injury and burnout rates; diversified participation is generally protective.

Heat illness risk in children is heightened by lower sweating rates and slower acclimatization; hydration and scheduled rest breaks are essential.

Screening for relative energy deficiency is important in adolescent athletes because low energy availability impairs growth and bone development.